The Doctor Is In

Every time Charlie comes back from the dentist, he breaks the law.

“I’ve had eight teeth pulled in four sessions, and each time I only needed the OxyContin for a few days, but I ended up with enough for more than a week,” said Charlie, a 26-year-old Brooklyn resident with no criminal record whose last name was withheld to protect his privacy.

So he gives the leftovers to friends—which, in law enforcement parlance, is a felony act of distribution of a controlled substance. It’s also common practice: More than 7 million Americans abuse or misuse prescription drugs each year, according to the National Institute on Drug Abuse.

“They’re pretty fun recreationally,” Charlie said, “and they make long bus rides fly by.”

Charlie’s OxyContin prescriptions were just four of the 22 million new painkiller prescriptions New York doctors wrote last year. The painkillers are so widely available and so addictive that they are fueling a national prescription drug abuse epidemic, according to the Office of National Drug Control Policy.

Elected officials have, for the most part, been slow to respond to the epidemic, but in New York, Attorney General Eric Schneiderman has made it a priority over his first two years in office.

Schneiderman, who helped push for the repeal of the Rockefeller drug laws as a member of the state Senate, sees the fight against prescription drugs as an opportunity to undo New York’s legacy of regressive drug policies and set a new, progressive example for other states across the country.

Schneiderman was a long-haired undergraduate at Amherst College in Massachusetts when Gov. Nelson Rockefeller signed the eponymous law in 1973. That same year President Richard Nixon created the federal Drug Enforcement Agency in response to growing national concern over illegal drug use and its relationship to crime. And in May of that year, a report from New York City Health Commissioner Gordon Chase warning about the growing peril of prescription drug abuse went unnoticed.

When Schneiderman graduated in 1977, his first job was at a Berkshire County prison, where he helped run an inmate drug treatment program. The experience is one he cited frequently as an attorney general candidate on the campaign trail in 2010.

“I guess what I learned during my two years working in the jail … was the degree to which alcoholism and substance abuse was related to street crime and violent crime and crimes against property,” Schneiderman said in an interview.

Other states began to pass laws similar to Rockefeller, and by 1986 President Ronald Reagan passed a national mandatory minimum sentencing law for drug crimes.

“Something really remarkable and unfortunate happened within the United States between the 1970s and the beginning of the last decade,” Schneiderman said. “There was this wave of legislation across the country, tough on crime—supposedly tough on crime; in fact, we realized in retrospect that a lot of it was counterproductive. Between the late ’70s and the late ’90s, this national movement had taken place, it had been done incrementally—and, frankly, my view was that a lot of the laws that were passed were not based on evidence; they were not based on any empirical data.”

Schneiderman said the movement was more political posturing by people who wanted to look tough on crime than a methodical approach directed at actually reducing crime and recidivism.

“The ideology that led us to believe that our safety depends on the mass incarceration of young African-American and Latino men was false,” Schneiderman said. “It was not supported by the empirical evidence. It may have been based on superstition … based on guesswork, but that’s not the way to do public policy.”

Reforming the Rockefeller drug laws became a common cause for New York Democrats over the last decade, even as it stalled in the Republican-controlled Senate. In 2002 both of the party’s candidates for governor, Carl McCall and Andrew Cuomo, called on then Gov. George Pataki to reform the laws, but to no avail.

It wasn’t until Democrats won control of the upper chamber in 2008 that the reforms started to become a reality.

That following year Schneiderman, then a member of the New York state Senate, led the coalition of lawmakers and advocates that successfully repealed some parts of the Rockefeller drug laws. It was the first step in a plan to reform the state’s drug policy.

For Schneiderman, the drug policy that replaces Rockefeller should be led by facts, research and evidence, and form a counterpoint to four decades of draconian mandatory minimum sentencing policy that put a generation of largely poor black and Hispanic New Yorkers in prisons built specifically to house them.

In 2012 he proposed a new Internet System for Tracking Over-Prescribing law, or I-STOP, which strengthens criminal penalties for doctors who overprescribe prescription painkillers and provides for the creation of a database to monitor prescriptions throughout the state. It’s been hailed by parents and pharmacists as one of the toughest prescription drug monitoring proposals in the country.

But doctors, pharmacists, manufacturers, distributors and civil rights organizations were all disturbed by various aspects of the bill, which places an increased burden of responsibility on doctors and creates a possibly violable database of any given patient’s medications.

Pharma companies spent heavily lobbying on the bill. The Healthcare Distribution Management Association, a trade organization of wholesalers, spent $90,000. OxyContin manufacturer Purdue Pharma spent $20,000. Pfizer, Inc. spent $108,000. By June, 42 different groups had passed through the Capitol to weigh in on I-STOP.

The Democratic majority that had finally reformed the Rockefeller laws had also been replaced by a new Republican majority in the state Senate, which remained skeptical that voters would reward changes to the drug laws that might be construed as more progressive on certain types of drug crime.

“I think a lot of political consultants were telling elected officials that no one ever got thrown out of office for being tougher on crime, which, really, people use as an excuse for not looking at the facts and figures about what actually works,” Schneiderman said, describing his approach to the I-STOP bill.

So Schneiderman set about selling it.

Parents and activists who had lost loved ones to prescription-drug-related crimes went on a statewide lobbying campaign, creating a groundswell of public support for the legislation.

“People do not realize how vast the epidemic is,” said Avi Israel, whose young son Michael committed suicide last year after becoming addicted to prescription painkillers a doctor prescribed for his Crohn’s disease. Avi worked with Schneiderman to promote the I-STOP bill, and has been trekking to D.C. to push for a similar bill nationally.

“In every fifth home in this country, there is someone who has taken prescription pain pills or Xanax or psychotropic drugs for depression or anxiety,” he said. “People don’t realize how bad these drugs are, because it comes from a doctor. You’re not going in the street buying heroin, but you’re getting synthetic heroin from your doctor.”

Schneiderman’s office issued a 70-page report on prescription drug abuse in January 2012, and followed it with a series of legislative roundtables.

Schneiderman’s report characterizes the crisis in the same terms once used to describe the crack and heroin epidemics of the 1970s and ’80s. He pointed out $467.7 billion in costs related to drug abuse nationwide, and drew up statistics on a rash of babies born addicted to prescription opiates because their mothers were users. He pointed out the growth in prescription-drug-related crime across New York State, and presented tables showing substance abuse programs devouring 20 percent—some $13 billion—of the state’s budget.

“This is all about opening people’s minds,” Schneiderman said. “Doing things differently is always a challenge. There are a lot of interests invested in the status quo whatever it is.”

The bill cleared a major hurdle when Sen. Kemp Hannon, the Republican chairman of the Senate Health Committee, agreed to move the legislation.

“There was little if any dissent on the fact that there was a problem,” said Hannon.

The question was what should be done.

The theory behind I-STOP represents a sea change in how drug crimes are handled. Where the Rockefeller laws ended up criminalizing the actions of poor blacks and Hispanics, prescription-drug-monitoring programs like I-STOP are as likely to affect the wealthy as they are to affect the poor.

One in five people who make more than $100,000 a year takes at least one prescription drug regularly, according to a study by Forbes magazine. Schneiderman’s report painted a picture of prescription drug users that looked almost egalitarian.

More than two-thirds of prescription drug abusers are fully employed, and one in five is addicted to painkillers because he or she was first prescribed them for chronic pain. In New York City the highest rates of prescriptions filled were in high- and medium-income neighborhoods, the report said.

All of this shocked Sen. Hannon, who said he hoped the bill would help bring about a change in the cavalier way people use prescription drugs.

“It’s just literally overprescribing,” he said, noting that the majority of teenagers who use illicit drugs first found them in their own homes. “We have to have more of an institutionalization, so that there will be nothing to use in the medicine cabinet for the young man or woman who wants to experiment with drugs.”

For Schneiderman, the hope is that his efforts to reshape drug policy in New York could have the kind of national impact that Eliot Spitzer had on financial institutions, and Andrew Cuomo had on the student loan industry.

Since March some of the victims’ advocates who worked with Schneiderman’s office on I-STOP have been working with members of Congress on a piece of national legislation designed to work much the same way the I-STOP bill does. In July Sen. Charles Grassley and Sen. Dianne Feinstein held a hearing on prescription drug abuse, and Rep. Mary Bono Mack, chairwoman of the Congressional Caucus on Prescription Drug Abuse, urged the Food and Drug Administration to expedite a review of current prescription painkiller guidelines, recommending time limits on prescriptions and restricted prescriptions for those who are in “moderate” pain.

“We believe that if a labeling change were made … to reflect the uncertainty and lack of evidence surrounding the safety and effectiveness of these drugs for the treatment of chronic noncancer pain, physicians would think twice before prescribing these highly addictive narcotics for ‘moderate’ pain such as a toothache or sore knee,” Bono Mack wrote in a letter to the FDA.

Avi Israel, who made his third lobbying trip to Washington last week, said it would be more difficult to pass national legislation than the New York bill.

“Everyone in Washington agrees, everyone knows we have a problem, it’s just that Congress has dried up funding, the political atmosphere in washington right now is not to spend any money on those kinds of causes,” Israel said.

Schneiderman predicted other states would follow suit in strengthening controls on prescription drugs. “I think as people have looked at these problems honestly and looked to the professionals and looked to the data, there’s a new debate going on about how our criminal justice system operates, and I think over the next 10 to 20 years you will see substantial changes in states all over the country and in our federal system,” he said.

People need to understand that the goal is finding the best way to reduce crime, and part of reducing crime is reducing drug addiction, Schneiderman explained—and that means being open to the idea that “some people need treatment more than they need jail.”

“I see I-STOP, Rockefeller reform, and even the work we’ve been doing more recently on synthetic drugs as part of the same process of letting the empirical evidence lead you, rather than superstition or political fear.”